Banerjee Rupa, Pal Partha, Hutfless Susan, Ganesh B Girish, Reddy D Nageshwar
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Division of Gastroenterology and Hepatology, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
Intest Res. 2019 Oct;17(4):486-495. doi: 10.5217/ir.2018.00174. Epub 2019 Aug 6.
BACKGROUND/AIMS: Information about familial aggregation of inflammatory bowel disease (IBD) in Asia is limited. We aimed to analyze the prevalence and risk of familial IBD in an Indian cohort and compare familial and sporadic cases.
Familial IBD cases were identified from a large prospectively maintained IBD registry. The prevalence of IBD in first- and seconddegree relatives of index cases was evaluated. The disease behavior was compared to that of sporadic cases.
Total 3,553 patients (ulcerative colitis [UC], 2,053; Crohn's disease [CD], 1,500) were included. Familial IBD was noted in 4.13% of CD and 4.34% of UC patients. Family history was commoner in pediatric group (< 18 years) (P= 0.0002; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.6-4.8). Majority had paternal transmission (UC, 67.42%; CD, 70.97%). Concordance of disease type was higher in UC (79.7%) compared to CD (37.1%). Familial IBD was associated with higher cumulative relapse rate (CD, P< 0.001; UC, P< 0.001), higher cumulative rate of surgery (CD, P< 0.001; UC, P< 0.001) and higher rate of biologic use (CD, P= 0.010; UC, P= 0.015). Pan-colitis was higher in familial UC (P= 0.003; OR, 1.935; 95% CI, 1.248-3.000). Fistulizing disease was commoner in familial CD (P= 0.041; OR, 2.044; 95% CI, 1.030-4.056).
The prevalence of familial IBD in India appears comparable to rest of Asia but lower than the West. It is associated with a younger age of onset, higher incidence of pan-colitis in UC and fistulizing complications in CD. Familial IBD has higher cumulative relapse, surgery and biologic use rates. Hence, family history of IBD could have important prognostic implications.
背景/目的：关于亚洲炎症性肠病（IBD）家族聚集性的信息有限。我们旨在分析印度队列中家族性IBD的患病率和风险，并比较家族性和散发性病例。
从一个大型前瞻性维护的IBD登记处识别家族性IBD病例。评估索引病例的一级和二级亲属中IBD的患病率。将疾病行为与散发性病例进行比较。
共纳入3553例患者（溃疡性结肠炎[UC]2053例；克罗恩病[CD]1500例）。在4.13%的CD患者和4.34%的UC患者中发现家族性IBD。家族史在儿童组（<18岁）中更为常见（P=0.0002；比值比[OR]，2.8；95%置信区间[CI]，1.6-4.8）。大多数为父系遗传（UC，67.42%；CD，70.97%）。UC中疾病类型的一致性高于CD（79.7%对37.1%）。家族性IBD与更高的累积复发率（CD，P<0.001；UC，P<0.001）、更高的累积手术率（CD，P<0.001；UC，P<0.001）和更高的生物制剂使用率（CD，P=0.010；UC，P=0.015）相关。家族性UC全结肠炎的发生率更高（P=0.003；OR，1.935；95%CI，1.248-3.000）。家族性CD中瘘管病更为常见（P=0.041；OR，2.044；95%CI，1.030-4.056）。
印度家族性IBD的患病率似乎与亚洲其他地区相当，但低于西方。它与发病年龄较轻、UC中全结肠炎的发生率较高以及CD中瘘管并发症的发生率较高相关。家族性IBD具有更高的累积复发率、手术率和生物制剂使用率。因此，IBD家族史可能具有重要的预后意义。
